P235 Burton Rd—� DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
t a yge; Dis osg1,^System - G.S. Chapt .130,Article 13C)
(Ground Absorption Sewa N fr
OWNER OR CONTRACTOR , 'e'`�' P S' '/, "^4 DATE '► "! , "' i PERMIT
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N? 235
LOCATION
SUBDIVISION NAME LOT NO.
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HOUSE ❑ MOBILE HOME BUSINESS ❑
NO. BEDROOMS NO BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:ro rJ t
WATER SUPPLY: Individual ublic ❑
IMPROVEMENTS PERMIT BY .•. r /°_ ,. 'L -r, : fi:
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CERTIFICATE OF COMPLETION
BY—
(8/16/73) , *Construction must
hOT AREA
S.R. NO. +`
SECTION OR BLOCK NO.
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800a1, -E�. Ft.
Three Bedroom House <T0,.O Gad 00 S Ft..�
Four Bedroom House
1000 Ga 1200 Sq. Ft.
.INSTALLED BY-+�--1rL?�.cw.�'�p„Z„
Date '07/f- 17T
ly with all other applicable State and local regulations
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